Atraumatic perforated penetrating aortic ulcer

An entity to remember

Abstract

A 52-year-old man presents to the emergency department with a 3-month history of dry cough and oppressive chest pain associated with dysphonia and exertional dyspnea. He reports that the symptoms have become more intense in the last week and today he has lipothymia. He does not report a traumatic history, nor does he have a personal or family history of coronary heart disease and his only risk factor is active smoking in the last 10 years. On physical examination, blood pressure 90/60 mmHg, heart rate 140 beats per minute and pale were found, there was no cardiopulmonary alteration, but generalized lymphadenopathy with maculopapular examama was observed in palms (Panel A). On the electrocardiogram there is only sinus tachycardia. Aortic pathology is suspected, angiotomography of the aorta is found, finding perforating ulcer perforated in the aorta (Panel B, C and D). Coronary angiography was performed without significant lesions, infection by human immunodeficiency virus was ruled out, it had serology for syphilis 1 in 64 dilutions. These findings are consistent with penetrating ulcer perforation in the nontraumatic transverse aorta due to secondary syphilis.